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OITE Prep Fredericks > Orthobullet Tests > Flashcards

Orthobullet Tests Flashcards

1
Q

Congenital Dislocation of Knee

A

Start with casting in flexion(4w)–>open procedure to quadriceps. THough to be quadriceps contracture

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2
Q

Short Head of Biceps Femoris Innervation?

A

Peroneal Division of Sciatic N.

All other hamstrings get from tibial division also both heads of gastroc

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3
Q

Botulinum Effect?

A

Decrease Release of Acetylcholine at NM JXN (pre-synaptic)

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4
Q

Myasthenia Gravis

A

Ig’s against acetylcholine receptors at NM JXN (post-synaptic). Tx acetylcholinesterase inhibitors and Thymectomy. Easy fatiguabilty, ptosis with upwards gaze

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5
Q

Dystrophin Effect?

A

acts to regulate CALCIUM influx at level of sacrolemma

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6
Q

Yield Point

A

Point on Stress/Strain when material goes from elastic behavior to plastic behavior

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7
Q

Terrible Triad?

A

Posteriorlateral elbow dislocation (LCL)
Coronoid Fracture
Radial Head Fracture

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8
Q

Aminoglycosides MOA?

A

30S Ribosomal Sub-unit

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9
Q

Penicilllin MOA?

A

Prevent bacterial cell wall synthesis

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10
Q

Macrolides MOA?

A

50S ribosomal sub-unit binding

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11
Q

Rifampin MOA?

A

inhibit RNA polymerase

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12
Q

Quinolones MOA?

A

DNA gyrase inhibition

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13
Q

With Knee Flexion Tibia/Femur Rotation?

A

Relative internal rotation of tibial about medial point, Relative lateral rotaitn of femur

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14
Q

How does distal lateral femur translate during knee flexion?

A

Posteriorly

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15
Q

Arthroscopic Lysis of adhesions considered ?

A

Usually after MUA failed for ROM, no infection, AFTER 3 months

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16
Q

Common problem after TKA revision?

A

Elevation of joint line (even with NL Flex/Ext gaps) need to augment femoral component

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17
Q

Snowboarders fracture?

A

Fracture of lateral process of talus (casting - ND, ORIF- displaced)

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18
Q

MSIS Major Criteria PJI

A
  1. Draining Sinus Tract
  2. Pathogen Isolation from 2 different samples
  3. 4 or 6 minor criteria
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19
Q

MSIS Minor Criteria

A
  1. ESR >30, CRP >10
  2. WBC >1,100 (synovial)
  3. Elevated PMN synovial WBC >70%
  4. Purulence in Joint
  5. > 5 PMN per HPF
  6. Organism isolated from 1 sample
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20
Q

Most common risk factor for humeral shaft non-union?

A

Vit D Deficiency

Tx: Compression plating and bone graft

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21
Q

Femoral Resurfacing vs THA

A

Better femoral bone stock preservation, High re-operation rates (loosening and femoral neck fracture), wear rate is same of both MonM

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22
Q

Acetabular Liner REvision associated with?

A

High dislocation rates

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23
Q

Ipsilateral Femoral Neck and Shaft Fractures treatment- Highest rates of mal-reduction?

A

Treatment with one implant: should use two separate implant devices

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24
Q

Patellectomy TKA?

A

lack of levear arm with patella decrases rate at which patella tendon prevents tibia from A–> P translation, stretched PCL/posterior capsule overtime (recurvatum), need to due Posterior substituting knee

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25
Q

Meniscus injury Risk Factures in Shatsker II

A

Joint depression >6mm

Joint Widening > 5mm

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26
Q

Remelting Versus Annealing?

A

Remelting removed MORE free-radicals but disrupts crystalline structure more. Therefore annealing has MORE free radicles but BETTER mechanical properties

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27
Q

Total Elbow in Elderly for complex distal humerus fracture?

A
  • Better outcomes
  • Better ROM
  • Decreased REvision rates compared to ORIF
    Cant lift more than 5-10 lb
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28
Q

Most common place for TB in spine?

A

Usually starts anterior, sparing of the disk space.

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29
Q

SSEP’s vs MEP

A
  • SSEPS- not good at monitoring anterior spinal pathways, NOT effected by Anesthesia
  • MEPS more sensitve and specific, CAN be effected by anesthesia
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30
Q

Most common site for vertebral TB in children?

A

anteiror aspect of lower THORacic spine. Usually DOES NOT violate endplate like bacterial infections do

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31
Q

Corticosteroids inhibit inflammatory process via inhibition of :

A

Phospholipase A2

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32
Q

Two types of CRPS?

A
  1. Reflex Sympothetic Dystrophy: no nerve lesions

2. Causalgia: may have assocaited nerve lesions

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33
Q

Middle glenohumeral ligament orientation to SS tendon when veiwing from posterior portal?

A

Crossed the posterior aspect of SS at 45d angle to insert on superrior labrum or glenoid

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34
Q

Vaughan-Jackson syndrome tendon ruptpure?

A
  • attritional wear of the extensor digiti quinti tendon with rupture
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35
Q

EIP in the 4th dorsal compartment ?

A

is ULNAR and DEEP to EDC

- EIP has most distal muscle belly

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36
Q

Pseudogout clinical apppearance?

A

weakly positive bifringent: blue

- Chondrocalcinosis: articular cartilage and meniscus

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37
Q

IOM from radius and ulna?

A
  • Central band and acessory bandrun from proximal radius to distal ulna orientation. All the other OLIBUE chords and band run from ulnar proximally to radius distally.
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38
Q

Keller Resection Arthroplasty patient?

A
  • Lower demand
  • NO dorsiflextion of proximal phalanx
  • Loss of motion, significant joint degen
  • removal of base of proximal phalanxx
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39
Q

Modic Type I Changes:

A

T1 Low, T2High signal(represented bone edema and inflammation)

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40
Q

Modic Type II (T1/T2)

A 
T1 High (conversion to fatty marrow
T2 High
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41
Q

Modic Type III (t1/T2)

A

T1 low, T2 Low- sclerosis

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42
Q

Weil shortening osteotomy:

A

MT shortening and plantar displacement of MT head. Should be made parallel to plnatar surface of foot to decrase likelihood of KONWN dorsiflxion deformity of MTP

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43
Q

Asia B injury (motor/sensory)

A
  • INCOMPLETE (perianal sensation/rectal sensation, sensation distal to level of injury
  • Some Sensory
  • NO MOTOR
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44
Q

Tarsal Navicular Stress Fracture Treatment:

A

Cast immbolization/ NWB

- Usually DX on CT (not seen on PFs)

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45
Q

Oblique diaphyseal rotational osteotomy of MT indications?

A

bunnionette deformity with IMN of 4-5th GREATER than 12degreess

  • for 7-12d you can do medializing chevron osteotomy
  • for less than 7d just do chielectomy
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46
Q

Adult spinal deformity extension of contruct to sacrum (benefits/complications)

A
  • improved saggital balance

- increase pseudoarthrosis

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47
Q

When does cauda equine need to be decompressed ?

A

Within 48 hours - no difference in outcomes if sooner

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48
Q

Treatment of Hallux rigidus in older, low deman patients?

A

keller resection arthroplasty- removal of proximal portion of proximal phalanx, osteophyte removal

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49
Q

Mortons Extension Orthosis:

A
  • Limits the extension of 1st MTP during push off of gain

- used for hallux Rigidus, TURF Toe

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50
Q

What does release of conjoined tendon in great toe do?

A
  • Hallux varus

- formed by lateral tendon of FHD and adductor hallicus

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51
Q

Potts disease progression:

A
  • TB of the spine (preferential anterior thoracic in children, leave endplates alone
  • Adults does NOT progress after disease
  • Children (40 ) will progress after resolution of disease
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52
Q

Acute Spinal chord injury steroid dosing

A

LOADING DOSE: 30mg/kg +5.4mg/kg/hr
<3 hours from presentaiont- for 224 total hours
3-8 hours: for 48 total hours
>8 hours- NO STEROIDS

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53
Q

Hallux rigidus secondary effects

A
  • decrease dorsiflexion
  • transverse metatarsalgia/stress fractures
  • inverted gait due to decrease dorsiflexion
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54
Q

Critical Lumbar Stenosis measurements?

A
  • <10mm on AP

- , 100mm2 on cross section on axial CT

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55
Q

C1 lateral mass screw trajectory?

A

10d medial

22c cephalad

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56
Q

Anterior Tarsal tunnel syndrome:

A

Radiation to dorsal 1st web space

- compression of DPN in the anterior tarsal tunnel

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57
Q

Most common location of Mortons neuroma?

A

between the 2-3rd MT heads, transverse intermetatrsal ligament

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58
Q

Baxters Nerve?

A

1st branch of lateral plantar nerve. May have tinels aat plantar medial heel with pain that radiates to 5th toe

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59
Q

Flexk sign lateral to fibula?

A

pathonogmonic for superior peroneal retinaculum and peroneal dislocation: PT->then may repair/tenodesis

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60
Q

Most common site for DPN entrapment?

A

THe inferior extensor retinaculum

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61
Q

Cavus Muscle Imbalances:

A

TA weak, Peroneal Longus Strong

Posterior tib stron, peroneal brevis weak

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62
Q

Cavus Foot deformity:

A
  • cavus
  • Hindfoot varus
  • Forefoot pronation
    Coleman block determines flexibility of hindfoot
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63
Q

Non flexible hindfoot in cavovarus?

A

Will need cacl osteotomy

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64
Q

“Floating toe deformity”

A
  • Usually due to Weil osteotomy used for metatosalgia.
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65
Q

Cavovarus foot correction algorithim and coleman blcok:

A
  • ID’s supple hindfoot or not- tell you if the cavus is driven by 1st ray or NOT. IF it corrects with block then driven by 1st ray, would correct with dorsiflexion osteotomy
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66
Q

Resection of Tibial sesamoid?

A

Hallux Valgus

67
Q

Resectin of Fibular sesamoid?

A

Hallux Varus

68
Q

Resection of both sesamoids?

A

cock up toe deformity

69
Q

Large DMAA (>10)?

A

Needs BIPLANAR chevron rather that normal chevron distal osteotomy

70
Q

Hallux Valgus Interphalangenous?

A
  • > 10d

- needs Akin (medial closing wedge) osteoetomy of proximal phalanx

71
Q

For joint inconcruence in hallux valgus, what does it need?

A

Distal soft tissue correction as well

72
Q

PTTI- acquired adult flat foot deformities?

A
  • Hindfot valgus,
  • Forefoot adbduction
  • Forefoot Varus
  • Planus
  • Mearys >4, Decrease calcaneal pitch, Decrase medial cuneiform floor height
73
Q

PTTI Stage IIA

A
  • Flatfoot
  • NO Single Leg raise
  • Flexible hindfoot
  • NORMAL Forefoot
74
Q

PTTI IIB

A
  • Flatfoot
  • no SLR
  • Flexible HIindfoot
  • FOREFOOT ABDCUTION
75
Q

RIGID hindfoot in PTTI indicates what intervention?

A

Need for arthrodesis

- Usually TRIPLE

76
Q

Acessory muscle/tendon in peroneal tendon sheath?

A

Peroneous Quartus- may be found in up to 21% of patients, increases volume of sheath

77
Q

What type of receptors activate the NF-kB pathway?

A

Toll-like receptors

  • Leads to production of MMPs
  • Stromelysins subgroup of mMPs
78
Q

Pathologic Scoliosis causes?

A
  • Osteoid osteoma (<1cm)
  • Osteoblastoma (>1.5cm)
  • Curves usually RIGID, occurs at APEX of deformity
  • osteoblastoma more likely to have neuro copromise (size)
  • Usually in posterior elements
79
Q

Pediatric Spinal Tumors and their locations?

A
  • Osteoid Osteoma- Posterior elements
  • Osteoblastoma- Posterior elements (>1.5cm)
  • Osteochondroma (PE, more cartilage
  • Osteogenic Sarcoma- PE
  • ABC- vertebral body
  • Eosiniphilic granuloma- Cervical- vertebral body
80
Q

What is best predictor of AIS curve progression?

A

peak growth velocity:

  • occurs in females jest BEFORE menarche and Risser Stage I
  • GIrls usually skeletally matrue 1.5 years after menarche
81
Q

Increase kyphosis, chin on chest, increased chin-brow-vertical angle?

A

Ankylosis spondylitis

  • May need PSO (30-40d correction per level)
  • Vertebral resection
  • C7-T1 osteotomy
  • Chin on chest needs C7 pedical removal (Posterior extension osteotomy)
82
Q

Prolonged delivery, lack of shoulder adbuction or ER?

A

Brachial plexopathy from birth
- Erbs better prognosis than Klumpke’s
- Erb’s- Upper nerves 5/6
- Klumpke’s- lowers8/T1
(have glenoid retorversion, posterior subluxation
- may nee Lat transfer, humerusER osteotomies- late disease

83
Q

What is a Putti sign?

A

compensatory scapulothorasic motion to ADDUCT the arm resulting in prominence of the superiormedial border of the scapula

84
Q

Adult Halo traction?

A

4 PINS at 6-8lbs of traction

  • safe zone is 1cm above and lateral 2/3 of orbit
  • most common complication is CN VI _lateral rectus
  • M->Supratrochlear–>Supraorbital->Lateral
85
Q

Cascade of superior facet facing in subaxial spine?

A

Goes from posterior medial in cephalad regions to posterior -lateral is caudal regions

86
Q

Flattened Facies, multiple joint dislocations, ligamentous hyperlaxity?

A

Larsens Syndrome
- radial head, knees are common dislocations
CERVICAL KYPHOSIS must be watched

87
Q

Chances of motor recovery of infant with total brachial plexus palsy AND Horners syndrom?

A

<10%

88
Q

Administration of BMP-2 at time of definitive fixation for Type IIIA and IIIB tibia fractures has shown what?

A

decreased risk of future bone grafting procedures needed

89
Q

Spondylolisthesis not seen on initial plain films, what is most sensitive study?

A

Bone scan with SPECT

90
Q

What are the joints WITH intra-articular metaphysis?

A

Hip, shoulder, elbow, ankle

NOT the KNEE

91
Q

What is Type I Muscle?

A
  • Slow twitch, needs O2, Aerobic, endurance

- Endurance training increases capillary denisty

92
Q

Strength training does what to muscle units?

A
  • increase recruitment

- hypertrophy>hyperplasia

93
Q

Outerbridge classiciation

A 
0- Normal Cartilage
1- Cartilage Softening and swelling
2- Fissues on surface that do NOT rach subchonral bone
3- Fissuring to subchondral bone
4- Exposed subchondral bone
94
Q

Transcription factors that lead to osteoclastogenesis?

A

RANKL

MCSF

95
Q

Where is most common locations of osteochondritis dessicans lesion?

A

MFC

- Doesn’t always involve cartilage, primarily lesin of subcondral bone, best predictor is open physis for recover

96
Q

What is most specific marker of osteoblast maturity?

A

Osteocalcin:

97
Q

Percutaneous Screw Fixation for femoral neck stress fracture indications?

A
  • Tension sided fractures

- Compression sided fractures that extend >50% across neck

98
Q

Sausage digit, nail pitting, “pencil in cup” diagnosis?

A

Psoriatic arthritis

99
Q

What Risser Stage does Peak Growth Velocity Occur in?

A

Risser Stage 0

- Olecranon fuses before initiation of Risser I–>5

100
Q

What is the main bood supply of the ACL?

A

Middle geniculate artery- branches from popliteal

  • PCL also from MGA (hemarthrosis)
  • Lateral and medial mesnisci (from inferior medial/lateral geniculate arteries)
101
Q

Rhuematoid arthritis ?

A
  • Periarticular erosions, symmetric joint degen, no osteophytes
  • Protrusio acetabuli, spares IP
  • MCP degen, ULNAR drift–> late disease get MCP arthroplasty
102
Q

Absolute contraindication to meniscal transplant?

A
  • Varus mal-alignment
  • ACl deficient
  • Grade IV chondromalacia
  • inflammatory arthritis
103
Q

ACL is primarily composed of what type of collagen?

A

90% TYPE I

- Dupuytrens contracture? Type III

104
Q

Enzyme in alkaptonuria (ochronosis)?

A

Homogentisic acid oxidase

  • early arthritis , blackened on gross spec
  • dark urine
105
Q

What molecule responsible for water content in nucleus pulposis?

A

AGGRECAN(ketarin and chondroitin sulfate)
- major contributor to COMPRESSIVE strength
Nulceous pulp: type II collagen- tensile strength
Annulus- Type I collagen- tensile strength

106
Q

Zone of cartilage”

A

Superficial: collagen PARALLEL to JOIN- LOW Proteoglycan
Intermedia: Random
Deep: Perpindicular to joint, HIGH Proteoglycan
Tidemark

107
Q

With a retorverted pelvis, what would be tight?

A

Hip flexors and hamstrings

- can be seen in hyperlordosis of spondylolisthesis

108
Q

Statistical Power Definition: finding as significant association when one truly exist–>formula

A

often set at 80%
- Type II error= incorrectly assuming th NULL hypothesis (there is true difference but you reject it)
Type I error: incorrectly REJECTING the null hypothesis

109
Q

Discoid meniscus surgery indications?

A
  • persistent pain or MOTION loss
110
Q

What is the lung met potential of giant cell tumor of bone?

A

4%

111
Q

What are the signs of rheumatoid cervical spondylitis?

A
  • Basilar invagination
  • Subaxial instability
  • atlanto-axial subluxation
112
Q

What is classic appeareance of vertebral hemangioma?

A

vertical striations in the vertebral body seen on saggital (on axial imaging would be boney spots)

113
Q

Langerhan’s histocytosis stain?

A

CD1

- birbeck ganules seen in cells

114
Q

Cancellous and cortical bone remodeling?

A
  • Cortical- cutting cone, osteoclastic tunneling

- Cancellour/Trabecular Bone ( Osteoclastic resorption)

115
Q

Cervical Stenosis Values?

A

> 13 nl
10-13mm- relative stenosis
<10mm absolute stenosis
Torg Ratio: <0.8 (canal/cervical body) -saggital

116
Q

What is the most common child-hood SOFT-tissue sarcoma?

A

Rhabdomyosarcoma

117
Q

Cohort versus case control study

A

Cohort- has risk and look to see disease

Case /Control- has case/disease- look back to see risk

118
Q

What is cascade of YOungs modulus?

A
  1. Ceramic
  2. Alloy (Co-Ch)
  3. Stainless steel (iron-carbon allow, molybdenum, Mg)
  4. Titanium
  5. Cortical Bone
  6. PMMA
    Cancellous bone
    Tendon/ligaments/cartilage
119
Q

Differential of Small, round, blue cell tumors?

A
  • neuroblastoma -<5yo
  • ewings sarcoma 5-15yo
  • Langerhans cells
  • lymphoma 15-40yo
  • Myeloma
  • small cell lung carcinoma
120
Q

ZPA

AER

A

Sone of polarizing activity- Radial-ulanr growth

Apical ectodermal ridge:- logitudnal growth

121
Q

Synovial Cell Sarcoma appearance nad translocation

A
  • Biphasic

- X-19

122
Q

Weinstien Group II

A

Cerebral palsy scoliosis with >15d of pelvic obliquity

- instrumentation to pelvic decrease late re-curreance and pseudarthrosis . With pelvic obliquity <15d can stop at L4/5

123
Q

Indications for Mehta casting (derotational) in infantial scoliosis?

A

RVAD >20d

Scoliosis >30d

124
Q

What could increase pseudarthrosis risk in patients with surgical ADULT idiopathic scoliosis?

A
  • Saggital balance > 5cm
  • Thoracoabdominal apporach
  • Age greater than 55
125
Q

TLICS scoring value for surgery?

A

> 4
Morphology (compression1, burst2, translation/rotation3, distration4
PLC: intact0, unsure2, out3
Neuro: normal, nerve root, incomplete 3, complete 2, cauda equina 3

126
Q

Fusion of the olecranon apophysis occurs at what age and in what direction?

A
  • Anterior to posterior

- from 15-17

127
Q

Ewings sarcoma Treatment?

Translation?

A

11:22
CD 99 stain
CHEMO, RESECTION, RADIATION; all three
Chemos is Vincristine/Doxorubicin/Dapto

128
Q

Osteosarcoma treatment algo?

A

Chemo (MTX) + Wide resection/amputation

129
Q

What is most common site of metastasis for osteosarcoma?

A

LUNG»Bone(second)

130
Q

What does over-resection fo posterior femoral condyles in PS knee cause?

A

Flexion instability (without dislocation)

131
Q

Atlantoaxial rotatory instability SCM relationship:

A

The CHIN will roate to side OPPOSITE of Facet subluxation of C1
- The SCM with we spastic 2/2 to that and be spastic on SAME side as chin
- in congenital torticollis, the SCM is spastic on OPPOSITE side of chin
NON-op fails–>C1/C2 fusion

132
Q

What are the common organisms of CHRONIC PJI

A
  • Coagulase Negative STAPH and Proprionibacterium
133
Q

Pleomorphic Sarcoma treatment?

A

Chemo, WR/ chemo. Like osteosarcoma. WIll look like it in imaging but Histo will be spindle cells, no osteoid

134
Q

What is the birfucate ligament in the foot?

A

Attaches to anterior process of the CALC to the Cuboid and navicular. Can cause boney avulasion fracture with pain on lateral aspect of foot

135
Q

PTHrP does what at the physis level?

A

Slows the maturation of proliferating chondrocytes

136
Q

Two sample T test vesus Mann-Whitney?

A

BOTH are for two MEANS

  • Two sample T- Parametric data
  • MW- NON-parametric data
137
Q

Myxoid Liposarcoma translocation?

A

12: 16

(2: 13)- alveolar rhabdomyosarcoma

138
Q

What is FDA approved medicaiton for treatment of Giant Cell tumor of bone?

A

Denosumab

139
Q

Treatment for Mulitple myeloma?

A
  • Surgical stablization
  • RADIATION
  • BISphosphonates
140
Q

Dabigatran MOA?

A

Direct Thrombin Inhibitor

141
Q

Rivaroxaban MOA?

A

Direct Facot Xa Inhibitor

142
Q

Heparin works via MOA?

A

Activation of antithormbin III (ATIII)

143
Q

What is the severe form of Lanherhand Cell histiocytosis that invovled visceral organs?

A

Hans-Shuller-Christian disease

144
Q

What spinal lesion is typical for Eosiniphillic granuloma?

A

Vertebra plana

145
Q

Coast of Maine hyperpigmentation?

A

McCune-Albright syndrome

  • Polyostotic fibrous dysplasia
  • Precocious puberty
  • endocrine distrubances
146
Q

Anti CCP is a marker for what ?

A

Rheumatoid Arthritis

147
Q

Side Effects

  • Bleomycin?
  • Doxorubicin?
A
  • Bleomycin- pulmonary fibrosis

- Doxirubicin: cardiomyopathy

148
Q

Giant cell tumors are usually NOT found in patients with open growth plates

A

THink UBC or ABC

149
Q

How long can you wait in ExFix in Femur? Tibia?

A

Femur- 3 weeks

Tibia- 7-10days

150
Q

Indications for Uni Arthroplasty?

A
  • ACL competent
  • , 10 d of mechanical axis off
  • , 15 d of flexion contracture
  • Non- inflammatory arthritis
151
Q

Botulinum works at what portion of synapse?

A

At PRESYNAPTIC release of ACH

152
Q

What do you haev to gt in JIA before surgery?

A

Cervical radiographs for instability

153
Q

Where and when do Chondroblastomas occur?

A

Usualy epiphysiUsualydo NOT occur after PHseal closure

154
Q

SNAC WRist Progression?

A 
Scaphoid NON unioin advanced colapse
1. radioscaphoid/radiostyloid
2. scaphoid capitate
3. Pancarpal
RADIOLUNATE is usually fine
PRC for 4CF- Have to do 4CF is capitate head is fucked
155
Q

Does volumtric wear rates in MoM hips follow typical increase in head size, increase in wear patter?

A

No because of incrase sliding speed in larger head

- though to be comparable volumetric rates at 28 and 36 due to this

156
Q

Wear rates are independent of femoral head size between what sizes?

A

28-42mm

157
Q

Most common complications withTKA follow HTO?

A
  1. Patellar Baja
  2. Diffcult exposure
  3. Instaiblity
158
Q

Metabolic Syndrome constellation?

A

HTN
HLD
Glucose intolerance
Central Obesity

159
Q

Stages of Perlunate dislocation ?

A
  1. SL ligament
  2. Luno- Capital articular
  3. LT ligament
  4. DRC ligament
160
Q

Continuous Variables NORMAL distribution test?

A

Student t test

161
Q

Continuous Varibles NON NORMAL distrubtion test?

A

Man Whitney U Test

162
Q

Two groups of categorical variables?

A

Chi -Square Test

163
Q

More than Two groups of variables

A

ANOVA

OITE Prep Fredericks (15 decks)

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